Homeopathy

Homeopathy is a pseudo-scientific alternative medicine based on the principles of similarity and "potentization." It posits that the most appropriate treatments for a disease are substances that cause similar symptoms in a healthy person. These treatments are prepared by a series of dilutions of the active substance followed by "succussion" (vigorous shaking of the product).

Homeopathy is frequently misassociated by the general public with other practices, particularly herbal medicine.

Uses and Regulations

Epidemiology

The use of homeopathy has been increasing worldwide since the early 1990s, with significant regional disparities. It has become prevalent in Europe (especially in France and Germany), India, and a few other countries. However, it remains marginal in most countries worldwide, either in favor of conventional medicine and/or other better-established alternative medicines. For example, the percentage of the adult population using homeopathy in a year is around 50% in France, while it is only 2% in the United States.

Sociologically, homeopathy use is more common among women, individuals aged 40 to 60, and middle to upper classes.

The majority of homeopathic product consumption is through self-medication.

All health problems are concerned, but the main pathologies are respiratory disorders, musculoskeletal disorders, chronic fatigue, sleep disorders, stress, and chronic pain.

Regulations

Most countries have no legal recognition and regulation regarding homeopathy, whether it be training, practice, production, sales, or reimbursements.

However, there are a few rare exceptions:

• Some countries consider homeopathy as a medical practice and reserve it for medical graduates and/or other healthcare professionals. In practice, these restrictions are rarely adhered to.
• Some countries partially reimburse homeopathic products through mandatory health insurance.
• Some countries restrict the sale of homeopathic products to pharmacies. However, they face challenges from online sales.
• The European Union requires any homeopathic product to obtain market authorization. However, this mainly involves registration and ensuring the absence of harmfulness, with no requirement for demonstrating efficacy.

Principles of Homeopathy

Principle of Similarity

This principle is not specific to homeopathy. It was already present in the Hippocratic corpus and the writings of Paracelsus. To some extent, it also underpinned the design of early vaccines.

However, the German physician Samuel Hahnemann, the creator of homeopathy in the 18th century, was the first to integrate it as the basis of a therapeutic practice. It was then an empirical deduction ("like cures like"), without any physiopathological reflection, drawn from the effectiveness of quinine (later demonstrated to contain quinine) against malaria and the observation that the administration of this bark could itself cause a fever.

Principle of Potentization: Dilution and Succussion

Initially, homeopathic preparations frequently contained toxic compounds such as arsenic, mercury, or belladonna and resulted in numerous side effects. To solve this problem, Hahnemann tested serial dilutions of his remedies associated with "succussion" (vigorous shaking) at each dilution. He claimed that, according to his observations, his remedies not only lost their toxicity but paradoxically became more effective.

He then developed a protocol for "dilution power" based on titration (e.g., the letter X means that each dilution was carried out at 1/10th, the letter C at 1/100th) and the number of series of dilutions. Thus, a preparation of "power 30C" underwent 30 series of potentization with a dilution of 1/100th at each step. The concentration of the active substance in the final product is thus 10^-60 of the starting product.

This principle of "potentization," defying all logic and resting on nothing, is the main reason for the rejection of homeopathy by the scientific community.

Contemporary Pseudo-scientific Theorizations

Homeopathy was intended only as a practice deduced from observations and claimed empirical (contested) effectiveness, without theoretical foundations or physiopathological hypotheses. However, at the end of the 20th century, various actors claimed to give "scientificity" to homeopathy.

The best-known among them, the "memory of water," was elaborated by the French physician Jacques Benveniste, employed by Boiron Laboratories. He published a study claiming to demonstrate that liquid water in contact with a substance had its molecular arrangement permanently altered even when the substance was no longer present. No independent laboratory has been able to reproduce the results claimed by Benveniste. This hypothesis is still debated in France but rejected by the global scientific community.

Other theories have since been formulated anecdotally, according to the fashions of the moment and without any published studies.

What Benefits? - Homeopathy in the Era of EBM

A widespread idea in the general public is that modern scientific trials would be unsuitable for homeopathy, and homeopaths would reject them as a matter of principle. This is incorrect.

Historically, Hahnemann himself claimed to base his practice on trials of his preparations against placebos. Unfortunately, his methods and results from the 18th century have no credibility today.

In the contemporary era of Evidence-Based Medicine, numerous studies have tested the effectiveness of homeopathy versus placebo for various pathologies. Unfortunately, the majority of these studies are of poor quality (non-significant results, faulty methodologies, obvious biases, etc.). Studies of quality show contradictory results.

Several meta-analyses of these studies have been conducted. All those retaining only high-quality studies conclude that there is currently no demonstration of the superiority of homeopathy over placebo for any pathology.

What Risks?

Toxicity - side effects

By definition, true homeopathic products are so diluted that they are not likely to be toxic. Moreover, no meta-analysis demonstrates any differences in side effects compared to placebos.

However, numerous incidents have involved "falsely homeopathic" preparations, containing insufficiently diluted or unspecified products. For example, more than 400 such incidents have been recorded by the FDA since 2009.

Illegal practice of medicine and practice of other alternative medicines

In most countries, homeopaths are mostly not medical doctors, and unfortunately, it is common for them not to advise patients to consult a doctor alongside their treatment. This sometimes leads to harmful diagnostic omissions.

Furthermore, many homeopaths also practice other alternative medicines with radically different foundations and benefit/risk profiles.

Confusion among Professionals - a Risk for Public Health Education

In European countries, it is increasingly common for doctors to practice homeopathy alongside their conventional practice, with or without additional "training." In France, this phenomenon concerns more than 30% of doctors.

This mixing of practices unfortunately leads to confusion among patients regarding the boundaries between different disciplines and undermines efforts to educate the public about health. There is also a risk of confusion among practitioners themselves regarding the contradictory foundations of their different practices, with a risk of diagnostic and therapeutic omissions.

In Conclusion...

There is no quality evidence regarding either the potential efficacy or toxicity of homeopathy. Considering the available data, it seems reasonable to recommend simply:

• No doctor should practice homeopathy. Simply put, homeopathy does not meet the contemporary requirements of conventional medicine, and "each to their own profession."
• No doctor should recommend the use of homeopathy.

Author(s):

Dr Shanan Khairi, MD

Bibliography

Dossett M, Homeopathy, uptodate, 2024

Frass M et al, Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review, Ochsner J 2012; 12:45